Project Summary/Abstract: Nearly 1 in 5 patients receiving community-based long-term care (CB-LTC) services transition to institutionalization in a nursing home within 3 years. CB-LTC patients who are institutionalized incur nearly $57,000 more per year in healthcare costs, have a significant reduction in quality of life, and higher mortality rates. Commonly, the downward spiral in health that results in institutionalization among vulnerable older adult patients starts with increased utilization of emergency room (ER) services and more frequent hospitalizations. Once an older adult is hospitalized, risk for institutionalization in nursing home is significantly higher. Because hospitalizations and ER visits often precede costly nursing home admissions, understanding risk factors? especially modifiable factors?for these outcomes is critical. However, there is limited research exploring the impact of objectively measured functional impairment on healthcare and other service utilization in the CB-LTC population. The purpose of the proposed study is to explore the effect of functional impairment on key health outcomes for older adults in CB-LTC settings, including emergency department use, hospitalizations, and nursing home admissions. The aims of this study are to: 1) Evaluate if impaired physical function is associated with frequency and timing of ER, hospital, and nursing home utilization in CB-LTC patients 2) Test whether including measures of functional impairment significantly improves prediction of ER visits, hospitalizations, and nursing home admissions in CB-LTC patients 3) Evaluate differences in patient factors and rehabilitation utilization between CB-LTC patients who experience functional decline and those who maintain or improve physical function over 1 year. The data for this proposed study will be extracted from a unique database of linked physical function, claims, and electronic medical record data on 1600 CB-LTC patients in a single clinic network. This study will use descriptive statistics, multi-level modeling, Poisson regression, and Cox- Proportional hazards regression analysis to analyze the data. The knowledge gained from this study will help us to understand the impact that impaired physical function has on healthcare utilization and outcomes for CB- LTC patients. This information will help clinicians and policy-makers as they develop interventions and services for this vulnerable patient population.